The Impact of the Covid-19 Surgical Pause on Operative Timings Elective Benign Gynaecological Surgery

Study Objective To assess the impact of Covid-19 global pandemic and surgical pause on operative timings in gynaecology. Design Retrospective cohort study of all laparoscopies and laparotomies undertaken in our gynaecological department (01/01/2019 - 31/12/2020). Cases and timings were identified using computerised theatre records and analysed using Excel. Setting Large National Health Service (NHS) University hospital in the United Kingdom Patients or Participants All gynaecological laparoscopies and laparotomies over 2-year period. Interventions The monthly median timings (anaesthetic, surgical, operative) were compared for 15 months (January 2019 - March 2020) preceding the Covid-19 measures being implemented with the subsequent 9 months (April - December 2020). The gynae-onccology, emergency and elective gynaecology groups were analysed separately to allow secondary assessment of the impact of surgical pause on surgical timings. Measurements and Main Results 1565 cases were performed (886 benign elective, 158 emergencies, 522 gynae-oncology) averaging 77 cases/month pre-Covid-19, 27 cases/month in the initial 3 months and 59 cases/month for the subsequent 6 months. The monthly median anaesthetic time increased from 25-31 minutes pre-Covid-19 to 50-53 minutes in the initial 3 months, with a slow return towards baseline over the subsequent 6 months (33-47 minutes). Surgical timings stayed within average monthly fluctuations in gynae-oncology and emergencies, however a clinically significant peak (245 minutes) was observed in benign elective operating times in the first full month of return compared to pre-Covid-19 (46-102 minutes). Conclusion There was a clinically significant increase in operative times following implementation of Covid-19 measures. The widest clinical impact was near doubling of anaesthetic time over the initial 3 months. The 6-week pause in operating also appeared to impact elective benign gynaecological surgical timings, however continued operating in gynae-oncology and emergencies appeared to have a protective effect on timings. These findings can aid effective surgical list planning to allow sufficient time for the additional measures on the return after the larger second wave.